Acute Antithrombotic Management Quiz

Treatment and Management of Cerebral Venous Thrombosis (CVT)

• Treatment for children during the acute phase of CVT is similar to that for adults, but the evidence is weaker due to the lack of large randomized trials in this age group.
• Management for patients with COVID-19 vaccine-associated thrombosis involves anticoagulation, intravenous immune globulin, and reserved platelet transfusions for cases of clinical relevant bleeding or high bleeding risk procedures.
• Anticoagulation with UFH or LMWH is considered appropriate treatment for acute CVT, based on available data on efficacy, rapid onset of effect, and reversibility.
• The International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) showed that more than 80 percent of patients were treated with anticoagulation.
• Two randomized controlled trials of anticoagulation in acute CVT have been published, with methodological problems and modest sample sizes.
• A meta-analysis of these two trials found that anticoagulant treatment for CVT may be associated with a reduced risk of death or dependency, though not statistically significant.
• Limited data suggest that LMWH is more effective than UFH and at least as safe for the treatment of CVT, based on small-scale trials and case-control studies.
• Anticoagulants appear to be safe to use in adult patients with CVT who have associated intracranial hemorrhage, with relatively low risks of new intracranial hemorrhage.
• The Berlin trial of intravenous heparin versus placebo was stopped prematurely due to excess mortality in the placebo arm, with significantly better outcomes for the heparin group.
• The Dutch trial of subcutaneous nadroparin versus placebo found a favorable outcome for LMWH followed by oral anticoagulation, though not statistically significant.
• In an open-label trial, 66 adults with CVT were randomly assigned to treatment with LMWH or UFH, showing significantly lower in-hospital mortality and a greater proportion of patients with complete recovery for the LMWH group.
• In a single-center double-blind trial, 52 cases of CVT were randomly assigned to treatment with LMWH or UFH, with no significant difference between the treatment groups in neurological deficits, disability, and mortality.